Energy Expenditure and Shivering Severity During Targeted Temperature Management at 36°C After Cardiac Arrest: A Case Series.
Makayla Cordoza, Lingtak-Neander Chan, Elizabeth Bridges and 2 others
PMID 32433069WHAT IT FOUND
Energy expenditure did not consistently drop in ventilated cardiac arrest patients cooled to 36°C compared with rewarming.
Shivering periods had higher energy expenditure, and bedside shivering scores could lag behind energy changes.
Key findings
01After rewarming, steady-state energy expenditure differed from 36°C maintenance by 150 kcal/24 h and 329 kcal/24 h in opposite directions.
02Mean energy expenditure during shivering periods exceeded no-shivering periods by 543 kcal/24 h and 553 kcal/24 h.
03Of 96 bedside shivering assessments, 14 took more than one 15-minute period to change the score despite a 20% or more change in energy expenditure.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case series with no comparison group, so it cannot show that cooling at 36°C changes outcomes or that shivering treatment works. Shivering prevention and treatment were not standardized: all patients received buspirone and forced-air counterwarming, while shivering was treated at the medical team's discretion with possible magnesium, sedation, meperidine, or neuromuscular blockade. Energy expenditure was linked to shivering scores after data collection using a 20% change threshold, and the score may not have changed at the same time as energy expenditure. Energy expenditure can fluctuate for reasons other than shivering, and an observation ended early because of equipment malfunction.
The easy way to misread this
Do not conclude that cooling to 36°C reliably lowers energy expenditure or improves patient outcomes. This was a descriptive case series with no control group, variable shivering treatment, and no outcome comparison.